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The U.S. House of Representatives approved billions in cuts to Medicaid that advocates warn would undermine the nation’s already fragile system of services and supports for older adults and people with disabilities.

Republicans in the House pushed through a bill designed to follow through on President Donald Trump’s domestic agenda early Thursday by a vote of 215 to 214 after intense negotiations.

The legislation known as the “One Big Beautiful Bill Act,” which now heads to the Senate, would impose work requirements on many Medicaid beneficiaries and mandates that states check individuals’ eligibility for the program more frequently, among other changes.

by Michelle Diament